Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review - terra incognita impairing treatment policies
Non-malarial febrile illness (NMFI) is responsible for much of the burden of preventable childhood mortality in low-income countries today. Progress is hampered by a lack of knowledge on the frequency and distribution of the pathogens involved. Addressing this deficiency is a vital first step to improving patient management, and prioritizing further research and diagnostic development. In collaboration with the Worldwide Antimalarial Resistance Network (WWARN), the University of Oxford, Mahosot Hospital in the Lao PDR, and the WHO Regional Office for the Western Pacific, FIND has published a set of interactive maps indicating identification of pathogens known to cause NMFI in the Mekong region, based on screening of more than 1,000 published studies of infectious diseases in Thailand, the Lao PDR, Cambodia, Viet Nam, Myanmar, and Yunnan Province of China.
The increasing use of point-of-care diagnostic tests that exclude malaria, coupled with a declining malaria burden in many endemic countries, is highlighting the inability of many health care systems to manage other causes of febrile disease. A lack of knowledge of distribution of these pathogens, and a lack of screening and point-of-care diagnostics to identify them, prevents effective management of these generally treatable contributors to disease burden.
Knowledge of the geographical distribution of major causes of non-malarial fever and diagnostic facilities in malaria endemic countries remains limited. A number of small-scale studies have been conducted in the past and a few are currently underway, but no global database exists to guide futures studies, and to guide health programmes in managing fever. Defining the populations at risk of major pathogens and their geographical distribution is essential to defining the needs for new point of care diagnostics for developing country populations. A map of febrile disease aetiology forms an invaluable resource to identify gaps in knowledge, to advocate for more attention in this area, and to guide further targeted surveys and the development of management strategies.
RDT use in a remote village setting in the Philippines
FIND and partners have concluded a pilot project to map knowledge of NMFI in Mekong region of Southeast Asia. Conducted in collaboration with the WWARN, the University of Oxford, Mahosot Hospital in the Lao PDR, and the WHO Regional Office for the Western Pacific, the project screened more than 1,000 published studies of infectious diseases in Thailand, the Lao PDR, Cambodia, Viet Nam, Myanmar, and Yunnan Province of China. The result is a set of interactive maps indicating identification of pathogens known to cause NMFI in the region, accessible through the WWARN website and published in PLoS ONE. These maps constitute a readily-accessible resource on pathogen distribution in the region to guide further research in NMFI distribution, the development of clinical algorithms to improve patient management, and prioritization of diagnostics development. The process is readily scalable, and the collaboration is seeking support to extend the project. Global maps of pathogen distribution would form a valuable basis for development of a rational approach to management of the high burden of acute febrile disease, particularly in malaria-negative cases.
FIND and partners are seeking support to extend this work; a global database could rapidly be developed as a starting point to a rational approach to this daunting and neglected health burden.